Americans are concerned about highway traffic safety and what
to do about older people who no longer drive safely. In response
to this concern, the Traffic Safety Plan For Older Persons
was established by the National Highway Traffic Safety
Administration (NHTSA) to identify the nature of safety problems
experienced by older persons and articulate actionable solutions
to these problems.

This investigation was initiated to determine if individuals
who have the opportunity to routinely observe the driving
behavior of functionally impaired drivers are able to identify
the unsafe older driver and intervene on that driver's behalf to
help limit or stop unsafe driving. The study was also initiated
to determine if family and friends may be a better trigger for
more extensive testing than periodic screening of all older
drivers. People in this position include family members and
friends who are frequently concerned about the driving safety of
older relatives and peers. NHTSAsponsored research
(McKnight and Urquijo, 1992) and the Illinois Retired Teachers
Association, Inc. (1990) survey have shown that family members
and friends rarely report driving difficulties to regulatory
authorities. The ability of families to deal with changes in
older adults' functioning has a lot to do with how the family
deals with problem situations (Aizenberg and Treas, 1985; Sterns,
Weis, and Perkins, 1984).

To ensure that high risk older drivers are identified before
they are involved in an injury or crash, the public has begun to
pressure state licensing agencies to test older drivers more
extensively and more frequently. The use of testing for older
adults may be reasonable, if it can be shown that potential
impairment is related to higher risk of crashes, and tests can
detect the capabilities known to be associated with driving risks
(Hunt, 1994; U.S. Department of Transportation National Highway
Traffic Safety Administration, 1992). Currently, increased
testing is problematic because it is imprecise, expensive, time
consuming, and is perceived by many people to be unfair and
discriminatory. A blanket driving licensing requirement based on
age alone would be difficult to defend as chronological age, per
se, does not lead to an increased risk of crashes (Marotolli,
Cooney, Wagner, Doucette, and Tenneti, 1994; Marotilli, Ostfield,
Merril, Perlman, Foley, and Cooney, 1993).

Unless there is compelling evidence to the contrary, older
adults should be encouraged to maintain their lifestyle and
activities, including driving. However, we can expect that if a
person lives long enough, at some point, agerelated changes
and declines in functional ability due to disease may alter the
performance level of critical skills needed to drive.

Given their responsibilities for the diagnosis and treatment
of health problems, health professionals are also in a critical
position to detect functional and medical conditions that may
compromise driving. They also have the responsibility of advising
clients about the level of appropriate activities, including
driving, in relation to their physical condition and medications
involved in treatment. The degree to which medical professionals
are aware of their responsibility to assist individuals in
enhancing their driving, limit when or whether they should drive,
or report older adults who should not be driving has not been
systematically researched. (Indeed, the nature of reporting
responsibility is debated among medical professionals
themselves). Health professionals need explicit guidelines and
assessment tools to identify and report patients with medical
impairments that jeopardize safe driving (Marotolli, 1993;
Rueben, 1993).

Project Objectives

Families, friends, physicians, law enforcement, and social and
community services should be provided with information to assist
older adults whose capabilities make them potentially
atrisk for unsafe driving. To determine the surest course
of action, NHTSA contracted with CREATIVE ACTION INC. the Beverly
Foundation, and the National Mobility Institute to conduct a
series of research studies:

 Review the literature and public information materials on family and
friends' involvement with driving decisions of older adults;

 Identify current state and provincial requirements and practices regarding
identification of high risk older drivers;